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Sami Sheikh Ali,1 Khalid A Kheirallah,2 Ghazi Sharkas,1 Mohammed Al-Nusair,2 Abdel-Hameed Al-Mistarehi,2 Mahmoud Ghazo,1 Ali Zeitawi,1 Saverio Bellizzi,3 Mohannad Ramadan,3 Jomana W Alsulaiman,4 Hamed Alzoubi,5 Adel Belbesi,1 Mohammed Z Allouh6,7 1Epidemics Management, Jordan Ministry of Health, Amman, Jordan; 2Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Emergency Program, World Health Organization, Jordan Country Office, Amman, Jordan; 4Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid, Jordan; 5Department of Microbiology and Immunology, Faculty of Medicine, Mutah University, Mutah, Jordan; 6Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 7Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesCorrespondence: Khalid A Kheirallah, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan, Tel +962 7 9611 9094, Email kkheiral@gmail.com Mohammed Z Allouh, Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, P. O. Box: 15551, Al Ain, United Arab Emirates, Tel +971 3 713 7551, Email m_allouh@uaeu.ac.aeBackground: Population-based serosurveillance is a cornerstone to furthering our understanding of the COVID-19 pandemic at the community levels. In Jordan, four waves (phases) of seroprevalence epidemiological investigations were conducted using representative population-based national samples. This study aims to estimate the population-based seropositivity, herd immunity, and vaccination coverage at the fourth wave.Methods: Multistage sampling technique was implemented to recruit a nationally representative sample for the fourth wave of the seroprevalence investigation (June to August 2021). Electronically collected data utilized a questionnaire on background demographics, chronic diseases, and COVID-19 vaccination history. Also, blood samples were collected to detect the presence of total Anti-SARS-CoV-2 IgM and IgG using Wantai/ELISA assays. Prevalence estimates were presented using percentage and 95% Confidence Intervals (C.I.).Results: There were 8821 participants included in this study, with a mean age of 31.3 years, and 61.7% were females. COVID-19 national seroprevalence and vaccination coverage estimates were 74.1% (95% C.I.: 73.1– 74.9%) and 38.4% (95% C.I.: 37.1– 39.6%), respectively. Among children, seroprevalence estimates were similar to unvaccinated adults. Among COVID-19 adults, 57.2% were vaccinated. Among vaccinated participants, 91.5% were seropositive, while among unvaccinated, 63.2% were seropositive. By age group, seroprevalence ranged between 53.0% and 86.9%. Seroprevalence estimates were significantly different by gender, vaccination status and dose, and residence.Conclusion: The reported interplay between seropositivity and vaccination coverage estimate seems insufficient to provide herd immunity levels to combat new variants of SARS-CoV-2. Children and healthcare workers seem to be an epidemiologically influential group in spreading COVID-19. As the globe is still grappling with SARS-CoV-2 infection, national seroepidemiological evidence from Jordan calls for more focus on vaccination coverage, especially among epidemiologically vulnerable groups, to optimize herd immunity.Keywords: SARS-CoV-2, COVID-19, seropositivity, seroprevalence, herd immunity, vaccination, Middle East, Jordan

Background: The WHO Regional Office for the Eastern Mediterranean and the United Nations System Staff College (UNSSC) launched the Leadership Programme on Epidemic and Pandemic Preparedness and Response during the second half of 2021. Aims: To reflect on the leadership roles and actions played by the WHO Jordan Country Office from the onset of the COVID-19 pandemic to date via the unique lens provided by the WHO EMRO/UNSSC course. Methods: The role of the Jordan WCO was reflected on through the unique lens provided by the WHO EMRO/UNSSC course, whose first cohort included COVID-19 pandemic responders in the Eastern Mediterranean countries. Results: The Jordan Country Office was successful in leveraging several aspects included in the Leadership Programme, such as leadership in times of crisis, strategic thinking and planning, emotional resilience, preparedness, adopting a system approach and multisectoral partnership-building. This was particularly evident through the generation of evidence for policy-making and promotion of equitable access to health. Conclusion: The experience of WHO country offices during COVID-19 can be examined through the lens of the EMRO/UNSSC course, which can further advance the search for better leadership in collaboration with national counterparts and partners.

Microbial secondary infections can contribute to an increase in the risk of mortality in COVID-19 patients, particularly in case of severe diseases. In this study, we collected and evaluated the clinical, laboratory and microbiological data of COVID-19 critical ill patients requiring intensive care (ICU) to evaluate the significance and the prognostic value of these parameters. One hundred seventy-eight ICU patients with severe COVID-19, hospitalized at the S. Francesco Hospital of Nuoro (Italy) in the period from March 2020 to May 2021, were enrolled in this study. Clinical data and microbiological results were collected. Blood chemistry parameters, relative to three different time points, were analyzed through multivariate and univariate statistical approaches. Seventy-four percent of the ICU COVID-19 patients had a negative outcome, while 26% had a favorable prognosis. A correlation between the laboratory parameters and days of hospitalization of the patients was observed with significant differences between the two groups. Moreover, Staphylococcus aureus, Enterococcus faecalis, Candida spp, Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently isolated microorganisms from all clinical specimens. Secondary infections play an important role in the clinical outcome. The analysis of the blood chemistry tests was found useful in monitoring the progression of COVID-19.

The first year of the Coronavirus disease (COVID-19) pandemic registered the highest number of children under the age of one year who did not receive basic vaccines since 2009. The pronounced rise in vaccine-preventable diseases in 2020 and 2021 was largely attributable to the disruption of the vaccine schedule for children around the world. Routine vaccinations were missed in consideration of movement restrictions to prevent the spread of COVID-19. On the other hand, health resources were re-allocated to COVID-19, resulting in strained health care systems and the marginalization of essential health services like routine vaccination campaigns. The COVID-19 pandemic has clearly illustrated the potential of vaccines in saving lives and preventing disabilities. The unequal roll-out of vaccination programmes has simultaneously deepened the existing gaps between high and low-income countries. Disruption in other key life-saving immunization programmes is driving these inequalities even further. Prompt and sustainable investments in routine immunization programmes, including catch-up vaccination strategies, are essential to avert the impact of years of neglect of this important public health issue. In particular, the recent declining trends in vaccination coverage are putting decades of progress at risk.

ObjectivesCaesarean section (CS) conducted before labour (prelabour CS (PLCS)), compared with vaginal birth, may pose additional maternal and perinatal risks. No multicountry analysis has examined PLCS in low-income and middle-income countries (LMICs). This study assessed rates, risk factors and associations of PLCS with perinatal outcomes in LMICs.DesignPopulation-based cross-sectional surveys.SettingDemographic and Health Surveys conducted between 2015 and 2018 in 26 LMICs (13 countries in Africa, 11 in Asia and 2 in the Americas).ParticipantsWomen aged 15–49 years with singleton term births.Outcome measuresMain outcomes were early neonatal mortality, neonatal mortality, early breastfeeding (within 1 hour of birth), skin-to-skin contact and duration of hospital stay.Results255 227 women were included in the main analysis. Average rates of primary PLCS ranged from 1.3% in Zambia to 19.5% in Maldives. Median PLCS rate was 1.8% in the poorest versus 5.8% in the richest subgroups.Higher maternal age, education, economic status and BMI, lower parity, urban residence, delivery in private hospitals, larger baby size, having health insurance, more antenatal care (ANC) visits, ANC by a doctor and ANC in private hospitals were associated with increased primary PLCS.Across the 26 countries, primary PLCS, compared with vaginal delivery, was associated with increased neonatal mortality (adjusted odds ratio, aOR 1.2, 95% CI 1.0 to 1.5), decreased early breastfeeding (aOR 0.4, 95% CI 0.3 to 0.5) and skin-to-skin contact (aOR 0.4, 95% CI 0.3 to 0.5) and longer hospital stay (aOR 6.6, 95% CI 5.9 to 7.4). No significant association was found for early neonatal mortality (aOR 1.2, 95% CI 0.9 to 1.5).ConclusionPrimary PLCS, compared with vaginal birth, is associated with adverse perinatal outcomes in singleton term pregnancies in LMICs. Caesarean births should be audited regularly to monitor trends, appropriateness and context-specific drivers of CS.

Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

In April 2019, a tuberculosis (TB) outbreak, likely triggered by re-activation of a highly contagious latent tuberculosis infection (LTBI) in a school teacher, was reported in a primary school in the Veneto Region (northeastern Italy). The infection, having probably been dormant for decades, rapidly spread further to two school teachers and up to 11 pupils, a total of 13 cases of active TB that received appropriate TB treatment. Ten out of the remaining 95 school staff members (10.5%) and 34/546 (6.2%) remaining school pupils tested positive on tuberculin skin test (TST). Moreover, 2% (2/97) of pupils attending the first year of junior secondary school within the same municipality during 2017/18 (having completed the above primary school) were also found positive on TST. Since none of 3 school teachers or 84 pupils who completed the last year of primary school in 2017 and attended the second year of a junior secondary school were found to be TST positive, the beginning of the outbreak was dated from January 2018 onwards. Therefore, active TB in the index case may have been potentially infectious and undiagnosed for about 14 months, leading to extensive exposure of close contacts, especially students (1). Anyone with recognized LTBI status – among school staff or pupils – was placed on prophylaxis with isoniazid for 6 months (1).

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The response to the COVID-19 pandemic have been driven by epidemiology, health system characteristics and control measures in form of social/physical distancing. Guidance, information and best practices have been characterized by territorial thinking with concentration on national health system and social contexts. Information was to a large extent provided from global entities such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and others. This bipolar response mechanism came to the detriment of regional and sub-regional levels. The development of the global pandemic was evaluated in terms of the performance of single countries without trying to reflect on possible regional or sub-regional results of similar characteristics in health system and social contexts. To have a clearer view of the issue of sub-regional similarities, we examined the WHO, Eastern Mediterranean Region. When examining the development of confirmed cases for countries in the region, we identified four different sub-groups similar in the development of the pandemic and the social distancing measure implemented. Despite the complicated situation, these groups gave space for thinking outside the box of traditional outbreaks or pandemic response. We think that this sub-regional approach could be very effective in addressing more characteristics and not geographically based analysis. Furthermore, this can be an area of additional conceptual approaches, modelling and concrete platforms for information and lessons learned exchange.

The importance of bringing an end to all forms of violence against women and girls has been fully recognized as central to the achievement of the Sustainable Development Goals (SDG), with particular emphasis on SDG 5 on gender equality and women's empowerment.[1] However, the extent of violence against women and girls across the world is alarming. One in three women around the world have experienced physical and/or sexual violence by an intimate partner or sexual violence by any perpetrator in their lifetime.

While SARS-CoV-2 has infected millions and claimed more than 250,000 lives, experts are warning that the impact of other diseases neglected due to the pandemic may be just as significant in the months and years to come. Specifically, when health systems are overwhelmed, and people refrain from visiting health facilities due to movement restrictions or fears about illness exposure, both direct mortality and indirect mortality from preventable and treatable conditions increase.1-3 Female genital mutilation (FGM), also named female genital cutting, is acknowledged as a violation of human rights of women.4 The United Nations Sustainable Development Goals called for the elimination of the practice by 2030.5 FGM is referred to as any procedure involving the alteration or excision of external female genitalia without medical indication,6 and 3 million women in the world are estimated to be at risk of undergoing this procedure annually.6 It is a major public health problem in several countries in Africa and Middle East,6,7 being almost universal in seven African countries (prevalence >85%).6 A report from UNICEF highlighted how this practice is still being widely carried out in 29 countries in Africa and in Middle East, despite the fact that at least 24 of these countries have legislation or some form of decrees against FGM.8 However, some evident progress is ongoing: under the new FGM amendment to the criminal law in Sudan that was approved very recently (22 April 2020), anyone who performs FGM either inside a medical establishment or elsewhere faces three years' imprisonment and fine. 9 Studies conducted in different settings have clearly showed an adverse effect of FGM on psychological, sexual and reproductive health unfavourable outcomes. 10 This includes posttraumatic stress disorder,11 dyspareunia and genitourinary complications. Adverse obstetric outcomes, such as increased risk for caesarean delivery, episiotomy and postpartum haemorrhage, are also more frequent.12 Scar tissue, especially in women with FGM type III (infibulation) can result in obstructed labour or obstetric trauma.13 It is known that in situations of conflicts and disaster, gender inequality, gender-based violence and violation of human rights are likely to increase, as protection and health system are disrupted, leaving acts of violence unpunished and condoned by the societies. This applies to health emergencies as well, including the current COVID-19 pandemic. FGM, early marriage and violence against women and girls are life-threatening, health and human rights challenge, due to the inequal relations, and patriarchal rules.14 Survivors are left no choice or right of determination over their bodies, physical, and sexual and reproductive health. Estimates provided by Avenir Health, Johns Hopkins University (USA) and Victoria University (Australia) predict that significant levels of lockdown-related disruption over 6 months may cause significant delays in programmes to end female genital mutilation, potentially leading to around 2 million more cases of FGM over the next decade than would otherwise have occurred.15 These striking figures become even more daunting when compounded with the expected additional 31 million cases of gender-based violence and the 13 million more child marriages over the next 10 years.15 Support to continued access to reproductive health care services and protection of the rights and dignity of all women and girls remains even more critical in contexts such as the current pandemic. To do so, preparedness and response plans must incorporate and integrate Female Genital Mutilation in Gender-Based Violence, and Sexual and Reproductive Health Programmes, including in community awareness initiatives and activities, thus ensuring risk mitigation as well as remote and mobile case management.

Objective To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. Methods The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees’ most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions—used as an indicator for having experienced eclampsia—and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. Results The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0–1.3), 1.7% (95% CI 1.5–2.1), and 1.7% (95% CI 1.5–2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4–3.2). Conclusion Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions. This article is protected by copyright. All rights reserved.

Improvement of women's access to abortion care in Italy during the COVID-19 pandemic is critical.

Study Objective To investigate the reasons for discontinuation of the last contraceptive method used among adolescent women with a current unintended pregnancy. Design Demographic and health, cross-sectional, surveys. Setting Thirty-five low- and middle-income countries. Participants We selected 2173 girls aged 15-19 years with a current unintended pregnancy, using a multistage cluster random sampling method. Interventions A questionnaire administered by trained interviewers, which included sociodemographic as well as individual maternal and contraceptive history, was used to collect data. Main Outcome Measures The prevalence of contraception utilization and the contribution of each reason for contraceptive discontinuation before the current unintended pregnancies. Results Almost three-quarters of adolescent women were not using any contraception before the current unintended pregnancy, and less than 1 in 100 was using a long-acting modern method. Among girls who last used a traditional method, 111/150 (74.0%) discontinued because of failure. Among girls who last used a long-acting modern method, 7/11 (63.6%) discontinued because of health concerns and side effects. Conclusion This study highlights that approximately 80.0% of adolescent women with an unintended pregnancy in 35 low- and middle-income countries were either nonusers or using traditional methods. An additional 20.4% were using a short-acting modern method. Long-acting methods would have prevented the overwhelming majority of unintended pregnancies, including the vast numbers from contraceptive failure.

Low birthweight is a crucial factor in child mortality and morbidity and affects almost 20% of infants worldwide, mostly in low- and middle-income countries.To assess the relationship between access to and quality of antenatal care and occurrence of low birth weight.We analysed data from 18 demographic and health surveys, from 2005 to 2013, including 69 446 children. The main study outcome was birthweight2.5 kg, and access to and number of antematal care visits were exposure variables. Moreover, antenatal care attendants and time of visit (trimester) were considered. Multiple logistic regression adjusted for sampling at primary and country level was utilized.At least 1 and ≥ 4 antenatal care consultations were both associated with decreased odds of low birth weight when compared to none and4 antenatal care consultations, respectively. Additional benefit stemmed from having skilled antenatal care attendants and the first antenatal care consultation during the first trimester.Proper antenatal care coverage during pregnancy is beneficial for preventing low birth weight in low- and middle-income countries.علاقة الحصول على الرعاية السابقة للولادة وجودتها بانخفاض الوزن عند الولادة: دلائل مستمَدة من 18 مسحاً صحياً سكانياً.سافيريو بيليزي، سوزانا بادريني.يُعد انخفاض الوزن عند الولادة أحد العوامل الحاسمة التي قد تؤدي إلى وَفَيَات الأطفال واعتلالهم، ويؤثّر على ما يقرب من 20٪ من الرُضَّع في جميع أنحاء العالم، ومعظمهم في البلدان المنخفضة والمتوسطة الدخل.هدفت هذه الدراسة إلى تقييم العلاقة بين الحصول على الرعاية السابقة للولادة وجودتها وانخفاض الوزن عند الولادة.أجرينا تحليلاً لبيانات مستمَدة من 18 مسحاً صحياً وسكانياً في الفترة من 2005 إلى 2013، شملت 69 446 طفلاً. وكانت نتيجة الدراسة الرئيسية أن الوزن عند الولادة أقل من 2.5 كجم، وكان الحصول على الرعاية السابقة للولادة وعدد الزيارات المتعلقة بها بمثابة متغيرات للتعرُّض. كما أخذت الدراسة بعين الاعتبار أخصائيي الرعاية السابقة للولادة، ووقت الزيارة (مرحلة الحمل كل ثلاثة أشهر)، واستُخدم انحدار لوجستي متعدد تم تصحيحه لمراعاة أخذ العينات على المستويين الأولي والقُطْري.ارتبط إجراء ما لا يقل عن زيارة طبية واحدة و 4 زيارات طبية أو أكثر فيما يتعلق بالرعاية السابقة للولادة بقلة احتمالات انخفاض الوزن عند الولادة مقارنةً بعدم إجراء زيارات طبية وإجراء أقل من 4 زيارات طبية، على التوالي. ونشأت فائدة إضافية من توفُّر أخصائيين ماهرين في تقديم الرعاية السابقة للولادة، وإجراء أول زيارة طبية فيما يتعلق بالرعاية السابقة للولادة أثناء الثلث الأول من الحمل.التغطية المناسبة بالرعاية السابقة للولادة أثناء الحمل مفيدة للوقاية من انخفاض الوزن عند الولادة في البلدان المنخفضة والمتوسطة الدخل.Utilisation qualitative des soins prénatals et faible poids de naissance : données issues de 18 enquêtes démographiques sur la santé.Le faible poids à la naissance est un facteur crucial de la mortalité et de la morbidité infantiles et touche près de 20 % des nourrissons dans le monde, principalement dans les pays à revenu faible et intermédiaire.La présente étude avait pour objet d’évaluer le lien entre l’accès aux soins prénatals et leur qualité d’une part, et le faible poids de naissance d’autre part.Nous avons analysé les données de 18 enquêtes démographiques et sanitaires, de 2005 à 2013, portant sur 69 446 enfants. Le principal résultat de l’étude concernait un poids de naissance inférieur à 2,5 kg. L ’ accès aux visites prénatales et le nombre de consultations étaient des variables d’exposition. En outre, le personnel de consultation prénatale et le calendrier des visites (trimestrielles) ont été pris en compte. La régression logistique multiple ajustée pour l ’ échantillonnage aux niveaux primaire et national a été utilisée.Deux facteurs, en l’occurrence le fait d’avoir au moins une consultation prénatale et un nombre de visites supérieur ou égal à quatre, ont été associés à une diminution de la probabilité de faible poids de naissance par rapport à l’absence de visite et à un nombre de consultations prénatales inférieur à quatre, respectivement. La mise à disposition de personnel de consultation prénatale qualifié et la première consultation prénatale prévue au cours du premier trimestre de la grossesse constituaient également des avantages.Une couverture adéquate des soins prénatals pendant la grossesse est bénéfique pour prévenir le faible poids de naissance dans les pays à revenu faible et intermédiaire.

Background Annually, around 7.9 million children are born with birth defects and the contribution of congenital malformations to neonatal mortality is generally high. Congenital malformations in children born to mothers with hypertensive disorders during pregnancy has marginally been explored. Methods Country incidence of congenital malformations was estimated using data on the 310 401 livebirths of the WHO Multicountry Survey which reported information from 359 facilities across 29 countries. A random-effect logistic regression model was utilized to explore the associations between six broad categories of congenital malformations and the four maternal hypertensive disorders “Chronic Hypertension”, “Preeclampsia” and “Eclampsia” and “Chronic hypertension with superimposed preeclampsia”. Results The occupied territories of Palestine presented the highest rates in all groups of malformation except for the “Lip/Cleft/Palate” category. Newborns of women with chronic maternal hypertension were associated with a 3.7 (95 % CI 1.3–10.7), 3.9 (95 % CI 1.7–9.0) and 4.2 (95 % CI 1.5–11.6) times increase in odds of renal, limb and lip/cleft/palate malformations respectively. Chronic hypertension with superimposed preeclampsia was associated with a 4.3 (95 % CI 1.3–14.4), 8.7 (95 % CI 2.5–30.2), 7.1 (95 % CI 2.1–23.5) and 8.2 (95 % CI 2.0–34.3) times increase in odds of neural tube/central nervous system, renal, limb and Lip/Cleft/Palate malformations. Conclusions This study shows that chronic hypertension in the maternal period exposes newborns to a significant risk of developing renal, limb and lip/cleft/palate congenital malformations, and the risk is further exacerbate by superimposing eclampsia. Additional research is needed to identify shared pathways of maternal hypertensive disorders and congenital malformations.

Several cases of spontaneous remission (SR) interrupting the invariably progressive course of untreated acute myeloblastic leukemia (AML) have been reported so far. We shall add to this series the hematological and cytogenetic SR occurring in a 72-yr-old man affected by AML following myelodysplastic syndrome. At diagnosis cytogenetic analysis showed the 48, xy, del (6) (p22-pter), +13, +14 karyotype. Owing to a lobar pneumonia, the chemotherapy was deferred and a broad spectrum antibiotic therapy was established. Supportive care included red cells and platelet transfusions and low-dose corticosteroid. Two months later, after the pneumonia had completely disappeared, a complete remission, lasting about 5 months, was documented on bone marrow morphological and cytogenetical examination, although some degree of myeloid dysplasia persisted. Possible mechanisms of the various SRs described during the course of AML are discussed with a review of the literature.

Within the ongoing Ebola outbreak in West Africa, separate scenarios reflect old contexts with well-known strategies to face the epidemic on one side and completely new and unprecedented situations requiring new approaches on the other side. While Senegal and Nigeria represent success stories on the implementation of appropriate standard public health measures for containment, Liberia, Sierra Leone, and Guinea require a major and innovative scale of actions to halt even more catastrophic consequences.